http://www.journalclub.org/2004/12/06/n35 Comments on the medical literature Wed, 13 Jul 2005 13:30:08 +0000 hourly 1 http://wordpress.org/?v=3.0.1 http://www.journalclub.org/2004/12/06/n35/comment-page-1#comment-2437 ABbowers Tue, 24 May 2005 16:11:32 +0000 http://www.journalclub.org/2004/12/06/n35#comment-2437 As a laboratory scientist, I am disappointed by Mr. Greene's initial assumption of faulty test values. Often, we have found that those values are caused by several mitigating factors. Among those the primary cause is specimen integrity which includes patient identification, collection and preparation. If these are done correctly, chances are that the values received are correct. The diagnosis may not be. As a laboratory scientist, I am disappointed by Mr. Greene’s initial assumption of faulty test values. Often, we have found that those values are caused by several mitigating factors. Among those the primary cause is specimen integrity which includes patient identification, collection and preparation. If these are done correctly, chances are that the values received are correct. The diagnosis may not be.

]]> http://www.journalclub.org/2004/12/06/n35/comment-page-1#comment-518 Bruce Tharp Thu, 13 Jan 2005 16:00:48 +0000 http://www.journalclub.org/2004/12/06/n35#comment-518 I agree with the above comment. I am a Radiologist who works occasionally at a small rural hospital where virtually every emergency or inpatient gets a D-Dimer study. I can not begin to express my frustration at the dollars we spend chasing positive D-Dimer studies with high dollar venous dopplers, lung scans and CT scans. Has anyone ever done a study on the positive predictive value of D-Dimer studies. I certainly can understand the negative predictive value, but it seems that this clinical test to this non-clinician is often overused and misunderstood. I agree with the above comment. I am a Radiologist who works occasionally at a small rural hospital where virtually every emergency or inpatient gets a D-Dimer study. I can not begin to express my frustration at the dollars we spend chasing positive D-Dimer studies with high dollar venous dopplers, lung scans and CT scans. Has anyone ever done a study on the positive predictive value of D-Dimer studies. I certainly can understand the negative predictive value, but it seems that this clinical test to this non-clinician is often overused and misunderstood.

]]> http://www.journalclub.org/2004/12/06/n35/comment-page-1#comment-215 jeffrey Greene Thu, 09 Dec 2004 02:25:45 +0000 http://www.journalclub.org/2004/12/06/n35#comment-215 In practice d-dimer assays are useless. They are negative only about 2o% of the time in inpatients and 30-40% of the time in outpatients. A negative may be somewhat useful, the work up can supposedly stop there. But in real life when the clinical suspicion is high, my first thought is did the lab screw up again. A positive d-dimer is so nonspecific it adds nothing to clinical suspicion. I frequently get consulted by physicians for patients with positive d-dimers and otherwise negative workups, the postive test being thought of in the same way as cardiac enzymes. I wish my hospital would stop offering it. In practice d-dimer assays are useless. They are negative only about 2o% of the time in inpatients and 30-40% of the time in outpatients. A negative may be somewhat useful, the work up can supposedly stop there. But in real life when the clinical suspicion is high, my first thought is did the lab screw up again. A positive d-dimer is so nonspecific it adds nothing to clinical suspicion. I frequently get consulted by physicians for patients with positive d-dimers and otherwise negative workups, the postive test being thought of in the same way as cardiac enzymes. I wish my hospital would stop offering it.

]]>